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Allergy: The History of a Modern Malady
Allergy: The History of a Modern Malady
Mark Jackson
Reaktion Books, 2007
288 pp., 25.00

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Breathing Space: How Allergies Shape Our Lives and Landscapes
Breathing Space: How Allergies Shape Our Lives and Landscapes
Gregg Mitman
Yale University Press, 2007
336 pp., 40.00

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J. Matthew Sleeth

The Big Sneeze

What allergies are telling us.

Lewis Thomas, the noted physician and essayist, mused openly on the allergic tendency of our species. He found the condition without teleological merit, and declared it a "mistake." Now two books—Mark Jackson's Allergy: The History if a Modern Malady and Gregg Mitman's Breathing Space, How Allergies Shape Our Lives and Landscapes—are available for those who wish to delve further into this "mistake" that affects 50 million Americans.

Both works are splendidly done. Of the two, Breathing Space is distinctly American while Jackson, a British author, takes a more Continental view. Mitman prefaces his book with a disclosure: he has a personal stake in our allergic landscape. He writes with the authority of one whose childhood was viewed from inside an asthmatic's oxygen tent, and as a parent who, regretfully, has passed this trait on to his son.

Just how long has society been plagued by asthma and hay fever? In his essay "The Summer Catarrh in 1938," E. B. White describes his own struggles with seasonal allergies and tells us of the first modern statesman to fall victim to allergy's ruin—Secretary of State Daniel Webster. According to White, "Webster had had Presidential ambitions but by this time it had become apparent to him that anyone whose runny nose bore a predictable relationship to the Gregorian calendar was not Presidential timber."

The history of allergy is a relatively recent one, confined to the last century and a half. Both authors point toward industrialization and the disruption of native landscapes as contributing causes. Cut down a forest, and pollen-bearing weeds such as goldenrod are encouraged. Build a roadway or rail line, and those living nearby breathe in more pollen.

Before the advent of effective pharmacologic treatment, the only escape from hay fever was to leave home and go on a road trip. Places such as Bethlehem, New Hampshire became the destination of those wishing to escape urban pollen. The high altitude of the White Mountains made a perfect setting for dozens of luxury hotels; a hay fever industry was launched complete with hay fever clubs, literature, and luxury rail lines.

Both Mitman and Jackson explore the lucrative nature of allergy from its beginnings. A century ago, one pundit observed: "In no other country does hay fever give so much employment or cause so much prosperity. It has come to deserve to be a plank in the national platform of the Republican Party." Not to be outdone by their eastern cousins, members of the Midwestern hay fever clubs sought solace in the breezes of upper Michigan. Congress got involved and created America's second national park on Mackinac Island for the "health, comfort, and pleasure" of the people.

If history has a lesson, however, it is that once word gets out of a secret paradise, that Shangri La is imperiled. In an effort to make areas of escape "more civilized," developers and tourists defeated the original purpose of such refuges from allergy. Goldenrod sprouted along the rail lines to Bethlehem, and dust surrounded new building sites on Mackinac Island.

As more Americans developed asthma, towns such as Colorado Springs and Tucson became year-round havens. But then Bermuda grass was planted in the Arizona desert and its streets were lined with pollinating trees. The result? By the late 1970s, when the incidence of asthma in Tucson was twice that of the national average, the city found itself consistently in violation of National Ambient Air Quality Standards.

Mitman's chapter "Choking Cities" puts a face on the plight of asthmatics too poor to escape. Moved to compassion after viewing a Gordon Parks photograph in Life magazine, Americans brought a young asthmatic from the slums of Rio de Janeiro to the United States for treatment: "On 7 July 1961, a forty-six-pound, malnourished twelve-year-old boy from a Rio de Janerio favela—or slum—stepped off a plane in Denver, hoping to escape the shackles of poverty and longing for a life free from the struggle to breathe." As readers, we rejoice with this young boy, yet thousands of Flavio's counterparts continue to suffer anonymously in the slums of Rio and Mexico City—and Harlem and New Orleans—with little hope of relief. Indeed, throughout his book, Mitman is particularly attentive to asthmatics trapped in such circumstances, revealing an aspect of poverty that has not received as much notice as it deserves.

Here and in other respects, Allergy and Breathing Space diverge in their emphases (although they do not disagree with one another—Mitman is enthusiastically cited by Jackson). Mitman's book is more accessible and engaging for the general reader. Those who wish to know more of the mechanisms of allergy and the history of our thinking about the subject—how it has been variously conceptualized—will find much of value in Jackson's book.

It is Jackson, for example, who introduces us to Clemens von Pirquet, the father of allergy science. Born in Vienna May 1874, Pirquet pioneered the discovery of the elusive relationships between antibody, antigen, and immunity. During Pirquet's day, it was accepted that if a bee stung you and death ensued, the bee's venom was the cause of death. The same was believed about invading bacteria. Radically and counterintuitively, Pirquet postulated that it was the body's own response to the venom or agent that caused symptoms and death. This is why Lewis Thomas referred to allergy as a "mistake."

Alas, the world was a harsh place for Pirquet. Mirroring the reactions he saw on a cellular level, Pirquet and his wife committed suicide in 1929. We owe much of our understanding of allergy to this single individual who coined the malady's very name.

But how do allergies work? How do they develop? We are not born with them. It's not possible to have an allergic reaction to penicillin, or bee venom, if we've not previously been exposed because the body has no antibodies present. In simple terms, an allergy develops when we are exposed to a foreign substance; the body's immune system then recognizes the foreign object as "not self" and makes antibodies. These antibodies are designed to work with chemicals and white blood cells to eliminate the invading substance. Sometimes they work too hard.

For example, when our body "sees" pollen invading the mucous membranes, antibodies (IgE type) may bind with the pollen and activate white blood cells (mast cells), causing them to release chemicals such as histamine. Histamine, in turn, causes our eyes to water, nose to run, and airways to contract.

Of the allergic responses, one of the most serious and debilitating is asthma. Asthma may be the result of antibodies reacting to proteins in pollen or dog dander. It may also result from irritants such as coal dust. Much time and effort has been spent trying to divine the relative importance of irritant versus allergenic causes of asthma. In the real world, this argument often plays out with enormous financial stakes. If soot from a smokestack causes a rise in asthma rates, it is convenient to blame it on allergens since coal soot is a known irritant but may not cause an immune reaction. This controversy mirrors the battles over asbestos' role in lung disease and cancer. The manufacturers of asbestos tried to blame the disease on cigarettes if a victim smoked, while cigarette manufacturers tried to blame cancer among smokers on asbestos. What became clear eventually was that the two were additive.

Last century, a similar debate raged concerning the relative contributing roles of smoke versus fog toward poor air in cities such as London. The word "smog" derives from a combination of the two. In the spirit of detente, I offer to resolve the current argument in a similar fashion by introducing the word "irrigen" to describe any agent or combination of irritant/allergenic agents that results in an asthma attack. Further, I offer the following recent case study:

During the summer of 1996, a dramatic irrigen-mediated event took place in Atlanta, Georgia. In an effort to decrease ground-level ozone during the Olympic Games, the city provided around-the-clock public transportation, adding 1,000 buses to the existing fleet, and closed the downtown to private cars. During the ensuing 17 days, automobile use declined by nearly 25 percent. Irrigens—including ozone, sulfur dioxide, fine particulate matter, nitrogen oxides, and volatile organic compounds—dropped by nearly a third.

The results of the Atlanta's irrigen experiment? Physician visits by asthmatics dropped by 40 percent. Emergency room visits for asthma decreased by 11 percent, and hospital visits decreased by 19 percent.

I telephoned Gregg Mitman—whom I hadn't met—to discuss the Atlanta study and more recent findings. We spoke about an eight-year-long study of children living close to busy roadways in California. It concluded that children who grew up by the freeways had a greater incidence of respiratory disease in youth, and are permanently at greater risk of heart and lung disease as a result of lung scarring.

In our discussion, Mitman came back to the social justice issues that accompany air pollution and asthma. Power plants, refineries, and highways are not typically located near wealthy neighborhoods. The placement of polluting businesses has long fallen under two rules: the well-known "NIMBY rule" (not in my backyard) is augmented by "the Golden Standard" (those who control the gold set the standards).

In my phone interview with Mitman, I sensed his compassion—and the frustration he feels with our lack of civic consciousness. His book—and Jackson's too, for that matter—might well have been subtitled, "The History of a People Who Didn't Learn." Both books reveal how disease prevention is often at odds with unfettered capitalism. If everyone had access to clean air, who could sell air purifiers, inhalers, and ion pumps?

Mitman spoke of his work at the University of Wisconsin Medical School, where they are re-examining their interventionist education in favor of a more preventive curriculum. When I asked if there is anything he would change about his book, he answered, "I'd just say everything more strongly."

When I hung up I thought about my last Saturday's activities. I'd spent the morning working with my wife and students from Asbury College. It was our third day cleaning out a streambed, about a mile from our home. We've pulled 43 tires, two dishwashers, a hot water heater, a bed, hundreds of feet of rusting wire, dozens of plastic jugs in various states of decomposition, three tubs of broken glass, and six pickup loads of metal piping out of the stream. Many of these objects are made of polycyclic hydrocarbons, which are known endocrine disruptors and cancer-causing agents. To date, we've removed about a third of the waste at this site.

The story of the stream is illustrative. It runs a short distance into the Kentucky River, where it meets the intake for our town's drinking water. I am stymied in removing all of the waste at this site (and at five other nearby sites) by a lack of resources. I don't have the backhoe or dump truck needed to move the automobiles and large tractor tires. For now, we will continue to drink the trash as it breaks down.

If I contracted leukemia from our town's waste stream, I could drive to the high-rise cancer treatment center up the road. In a short period of time my insurance would pay tens of thousands of dollars in an effort to restore me. In our world, we "run for the cure" but ignore the cause.

Prevention cannot be deregulated or privatized; it is a civic activity. I—and future generations—thank the authors of these two books for their contributions to the case for prevention.

J. Matthew Sleeth, a physician, is U.S. director of A Rocha: Christians in Conservation (www.arocha.org). He is the author of Serve God, Save the Planet (Chelsea Green/Zondervan).

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